Can Anemia Cause Depression and Anxiety? The Hidden Link Between Iron Deficiency + Mental Health

What is anemia?

Iron is one of the most common deficiencies in the world - especially among women - but is often overlooked. Symptoms of iron deficiency can include:

• Extreme fatigue
• Weakness
• Pale skin
• Chest pain, fast heartbeat, or shortness of breath
• Headache, dizziness or lightheadedness
• Cold hands and feet
• Inflammation or soreness of your tongue
• Brittle nails
• Unusual cravings for non-nutritive substances, such as ice, dirt, or starch
• Poor appetite

These symptoms are often missed because they are vague and can also be attributed to other deficiencies or health issues, like low thyroid or chronic fatigue syndrome. I often uncover iron deficiencies in patients that have seen multiple doctors without much luck getting to the root cause of their health issues. 

Iron is vital because it helps carry oxygen to our cells and plays a role (1) in everything from muscle metabolism, to neurological development, to the synthesis of different hormones. Since our bodies don’t produce iron naturally, we have to get it through the foods we eat. And that’s where the problem occurs and why many people end up needing to supplement. Not everyone eats a diet that is rich in iron or they have underlying gut problems that inhibit their ability to absorb iron from food or supplements.

While a lot of people consider anemia and iron deficiency one and the same, that isn’t necessarily true. You can have low iron levels without being anemic. There are actually a few different types of anemia but they all are categorized by a lack of red blood cells or the presence of dysfunctional red blood cells in the body leading to reduced oxygen flow to your organs. But for this article we are going to focus on iron deficiency anemia.

This type of anemia happens as a result of your iron levels dipping below a certain level for a prolonged period of time. You can usually test for iron deficiency anemia by looking at hemoglobin levels. Hemoglobin is the protein in red blood cells that is responsible for transporting oxygen and also gives blood that deep red color. People who have anemia don’t have enough of this protein.

It is estimated (2) that 1 out of 5 women have iron deficiency anemia, most likely due to factors like menstruation and that they require almost twice as much as men do. 

To diagnose iron deficiency anemia, I like to run a few different labs:

• A complete blood count (CBC): This would tell us your red blood cell count and your hemoglobin levels. If either are low, you may be anemic. 
• Iron blood test: This test would tell us how much iron is in your blood but it is not foolproof because even if this test is normal, the amount of iron in the rest of your body may be low. 
• Ferritin test: Ferritin is a protein that helps store iron in your body. If it’s low, it’s a sign that your body’s iron may also be low. 
• Reticulocyte count: Reticulocytes are young red blood cells and if your levels are low, it’s a good sign that iron is also low. 
• Peripheral smear: This test looks at your red blood cells under a microscope to see if they are smaller or paler than they should be. If they are, that’s a sign that iron is low! 

Typically, a diagnosis is made when more than one test indicates a deficiency. 

Is there a link between anemia and depression?

Can anemia affect you mentally? The answer is a resounding yes. As a functional medicine practitioner, I see a lot of patients come in with anemia who also have mental health struggles. While these two health problems couldn’t seem more unrelated, once you understand the mechanisms by which your body utilizes certain nutrients like iron, you can see just how important it is to correct these deficiencies for vibrant mental health.

The answer to how can anemia cause depression is found in iron’s relationship with dopamine. In order for your brain to produce dopamine it needs iron. Dopamine is created when your body turns tyrosine that we get through protein-rich foods but it can only do that through the help of iron. 

One of the most recent studies on this relationship was published in 2020 in BMC Psychiatry (3) where it found that depression along with anxiety and sleep disorders were significantly higher amongst people with iron deficiency anemia.

While more studies need to be done on how iron affects mental health problems, research is beginning to see how iron plays a role in mood and emotional states. In the case of iron deficiency, not enough iron is passing through the blood-brain barrier into your brain which ends up affecting (4) neurotransmitter function and pathways involved in mood regulation.

Tips for keeping iron levels up

Considering iron deficiency is so common, it’s vital to pay attention to your levels in order to avoid anemia. These are some of the most basic, tried and true tips for keeping your iron levels up naturally.

1. Get your nutrient levels checked

The first step to addressing any deficiency is to know your baseline. Are you trending toward anemia, are you already anemic, or just need to focus on maintaining your current levels? All of this can be determined through blood work. In conventional medicine, (2) your iron levels should be 10-30 umol/L and your ferritin should be between 40-300 ug/L for men and between 20-200 ug/L for women. Once you know where you stand your doctor can help you come up with a plan of action including supplementation and dietary changes.

2. Eat more iron-rich foods

I believe food is foundational when it comes to your health. Supplements can be helpful when correcting deficiencies but food will help you reach optimal levels faster and maintain them long-term. While there are many foods fortified and enriched with iron, they are highly processed and not ideal. Some of the highest clean food sources of iron include:

• Lean beef
• Oysters
• Chicken
• Turkey
• Beans and lentils
• Tofu
• Baked potatoes
• Cashews
• Dark green leafy vegetables such as spinach

3. Eat more Vitamin C-rich foods

Take advantage of vitamin synergy and eat more vitamin C-rich foods that help enhance your body’s absorption of iron. You can find Vitamin C naturally (5) in:

• Broccoli
• Grapefruit
• Kiwi
• Leafy greens
• Melons
• Oranges
• Peppers
• Strawberries
• Tangerines

4. Correct any gut dysfunctions

Your brain health is directly correlated to the status of your gut health. These two systems form from the same fetal tissue and continue their connection through the gut-brain axis for the rest of your life. A perfect example of this is your happy neurotransmitter serotonin. What most people don’t realize is that the majority of serotonin is actually produced and stored in your gut - not your brain.

Plus, if you have a leaky gut - a condition where your gut lining is compromised - you are likely going to have trouble absorbing nutrients from food or supplements - including iron.

Symptoms of anxiety and depression

We all have days where we feel sad and times where we are anxious. However, according to the Anxiety and Depression Association of America, (6) anxiety disorders and clinical depression have a specific set of symptoms that continue for more than just a day or two at a time.

• Feeling hopeless
• Feeling worthless
• Loss of interest in activities you once enjoyed
• Chronic fatigue
• Trouble concentrating
• Decreased appetite and weight loss
• Overeating and weight gain
• Irritability
• Insomnia
• Suicidal thoughts
• Frequent headaches
• Digestive distress

If you are struggling with any of these symptoms, it is essential that you seek out proper medical care and counseling to address your mental health.

Tips for coping with anxiety and depression

Thankfully, there are many tools to help cope with anxiety and depression and natural ways to overcome these mental health problems.

Some coping strategies include: 

• A daily mindfulness practice (breathwork, meditation, journaling)
• Spending time in nature 
• Exercise to increase endorphin production
• Regular counseling
• A daily gratitude practice

If you are in the midst of mental health struggles and need more guidance on where to get help, call the SAMHSA hotline at 1-800-662-HELP (4357). This hotline is a free and confidential resource for referrals to local treatment facilities, support groups, and community-based organizations.

For more ways to address anxiety and depression naturally, check out my article here.

Seeking help from a functional medicine doctor

Now that we know the answer to the question “can anemia cause depression?” is yes, it is thankfully something that can typically be addressed without needing more invasive procedures or protocols. If you are experiencing any of the symptoms of iron deficiency or anemia, especially coupled with feelings of depression or anxiety, it’s important to seek out help from a functional medicine doctor who can help you correct deficiencies. 

Just remember that while we can help you address the physiological aspects to depression and anxiety in terms of nutrient deficiencies, it is still important to also work with a qualified counselor who can help walk you through the mental and emotional aspects of depression and anxiety.

In my telehealth functional medicine clinic. I specialize in identifying the root cause behind your health problems. By looking at your health as a whole, we aim to make connections between deficiencies and your symptoms, so that we can help you reclaim your health.

If you are ready to take action on your health, schedule a telehealth functional medicine consultation.

As one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe.

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